Umbilical arterial N-terminal pro-B-type natriuretic peptide levels in preeclampsia, fetal growth restriction, preterm birth and fetal distress.

OBJECTIVE: To evaluate fetal cardiopulmonary stress in pregnancies complicated by preeclampsia (PE), fetal growth restriction (FGR), preterm birth (PT), and fetal distress (FD) using umbilical arterial blood N-terminal pro-B-type natriuretic peptide (NT-proBNP). MATERIALS AND METHODS: The study included 146 blood samples that were drawn from umbilical arteries at the time of delivery (20 cases of PE, 11 cases of FGR, 31 cases of PT, 23 cases of FD, and 61 cases of gestational age-matched controls) and analyzed. The main outcome measures included neonatal birthweight, cord pH, and umbilical arterial NT-proBNP. RESULTS: The umbilical arterial NT-proBNP levels were significantly higher in the PE, FGR, PT, and FD groups than in the control group. The umbilical arterial NT-proBNP levels were negatively correlated with gestational age, birthweight, and umbilical arterial pH. CONCLUSIONS: Umbilical arterial NT-proBNP levels are elevated in stressful fetal conditions and have the potential to be considered as a marker for fetal cardiopulmonary stress.

A case of prenatally diagnosed Uhl's anomaly.

BACKGROUND: Uhl's anomaly is an extremely rare cardiac defect characterized by absence of the myocardium of the right ventricle. Until now, only three cases have been diagnosed or have showed suspicious diagnosis in prenatal period. CASE: A 28-year-old nulliparous woman was referred to the present hospital for counseling the risk of drug medication. The authors found dilatation of the right ventricle and thinning of the right ventricular wall in the fetus at 25 weeks gestation. No other structural abnormalities were found concerning the great arteries and all heart valves demonstrated normal function. Uhl's anomaly was suspected on fetal echocardiography and it was confirmed postnatally by echocardiography and computed tomography (CT). The infant showed stable condition during neonatal period and is doing well in the ambulatory care after three-years follow up: CONCLUSION: Although the outcomes of Uhl's anomaly are generally unfavorable, the duration of survival shows wide variation according to the cardiac function. To estimate the postnatal outcomes, it is highly recommended to perform the accurate differential diagnosis by using fetal echocardiography during pregnancy.

The influence of ritodrine alone or in combination with nifedipine on maternal cardiovascular side effects and pregnancy outcomes.

OBJECTIVE: To compare the influence of ritodrine alone or in combination with nifedipine on maternal side effects and suppressing preterm labor. MATERIALS AND METHODS: This retrospective study included 213 pregnancies with preterm labor (20-34 weeks) from May 2002 to April 2010 in Kyungpook National University Hospital in Daegu, Korea. Obstetric medical records were reviewed for both maternal characteristics and neonatal outcomes, including birth weight, Apgar score, admission to neonatal intensive care unit (NICU), ventilator support, and neonatal mortality. Maternal side effects such as tachycardia, pulmonary edema, and hyperglycemia were also reviewed. RESULTS: Of 213 patients, 109 received ritodrine only and 104 were given ritodrine and nifedipine. There was no statistical difference between the two groups with regards to pregnancy outcomes and neonatal complications. Pregnancy prolongation over seven days was achieved more in the combination therapy group, with borderline statistical significance (59.6% vs. 72.1%, p = 0.055). Sixty-nine cases experienced maternal side effects; four cases were categorized as serious and 65 cases were mild. CONCLUSION: In the treatment of preterm labor, the combination regimen of ritodrine and nifedipine can be more effective than ritodrine alone for prolonging gestation over seven days. Moreover, as the combination did not cause severe maternal side effects, it may be considered as a safe and effective method to prolong gestation in patients with preterm labor.

A case of ovarian endometrioid adenocarcinoma with yolk sac tumor in a 35-year-old woman.

Ovarian yolk sac tumor (YST) is a malignant ovarian neoplasm differentiated from primordial germ cells that occur in young age, while endometrioid carcinoma (ECA) is a müllerian epithelial tumor that usually occurs in older patients. The coexistence of an ovarian ECA and YST component is very rare. Only 12 cases have been reported until now according to a Medline search of the English literatures. We present a case of a simultaneous ECA and a YST component in a 35-year-old woman. Exploratory laparotomy was performed. The parts of both ovaries that showed an endometrioid-like glandular pattern were positive for cytokeratin 7 and negative for AFP, but the YST component was negative for cytokeratin 7 and positive for AFP. After completion of four courses of BEP chemotherapy, two courses of taxane and carboplatin chemotherapy were added. The patient failed to respond and succumbed to the disease after 12 months of follow-up.

Fitz-Hugh-Curtis Syndrome: single centre experiences.

This study was conducted to report 10 cases of Fitz-Hugh-Curtis Syndrome (FHCS) diagnosed with CT and 101 cases of FHCS-like lesion that suggested perihepatitis during laparoscopic surgery. We reviewed retrospectively the images of 3,674 laparoscopies for obstetrical and gynaecological diseases and analysed 10 cases of FHCS diagnosed by clinical patterns and CT. All the 10 cases showed liver capsular enhancement on CT. Among the 3,674 laparoscopies, we found 101 cases (2.7%) with FHCS like lesion. Among them, 23 cases were during laparoscopic procedure for endometriosis, 16 for gynaecological malignant tumours, 16 for benign adnexal diseases excluding endometriosis, 13 for uterine leiomyoma, 7 for pelvic inflammatory disease, 2 had peritoneal tuberculosis and 21 for other gynaecological diseases. Further consideration should be given for the causes of FHCS other than N. gonorrhoeae and C. trachomatis. Because FHCS may represent various clinical phases, other considerations and clinical classifications are necessary for treatment.

Elasticity of alveolar bone near dental implant-bone interfaces after one month's healing.

Information is scarce about Young's modulus of healing bone surrounding an implant. The purpose of this preliminary study is to quantify elastic properties of pig alveolar bone that has healed for 1 month around titanium threaded dental implants, using the nanoindentation method. Two 2-year-old Sinclair miniswine were used for the study. Nanoindentation tests perpendicular to the bucco-lingual cross section were performed on harvested implant-bone blocks using the Hysitron TriboScope III. Nomarski differential interference contrast microscopy was used to identify pyramidal indentation measurements that were from bone. Reduced moduli, averaged for all anatomical regions, were found to start low (6.17 GPa) at the interface and gradually increase (slope=0.014) to a distance of 150 microm (7.89 GPa) from the implant surface, and then flatten to a slope of 0.001 from 150 to 1500 microm (10.13 GPa). Mean reduced modulus and its relationship to distance did not differ significantly by anatomic location (e.g., coronal, middle, and apical third; P>/=0.28 for all relevant tests) at 1 month after implantation.

Elastic properties and apparent density of human edentulous maxilla and mandible.

The aim of this study was to determine whether elastic properties and apparent density of bone differ in different anatomical regions of the maxilla and mandible. Additional analyses assessed how elastic properties and apparent density were related. Four pairs of edentulous maxilla and mandibles were retrieved from fresh human cadavers. Bone samples from four anatomical regions (maxillary anterior, maxillary posterior, mandibular anterior, mandibular posterior) were obtained. Elastic modulus (EM) and hardness (H) were measured using the nano-indentation technique. Bone samples containing cortical and trabecular bone were used to measure composite apparent density (cAD) using Archimedes' principle. Statistical analyses used repeated measures ANOVA and Pearson correlations. Bone physical properties differed between regions of the maxilla and mandible. Generally, mandible had higher physical property measurements than maxilla. EM and H were higher in posterior than in anterior regions; the reverse was true for cAD. Posterior maxillary cAD was significantly lower than that in the three other regions.

Experimentally induced abutment strains in three types of single-molar implant restorations.

STATEMENT OF PROBLEM: The choice of single-molar implant design is difficult because of a lack of controlled, quantitative biomechanical analyses. PURPOSE: This study determined the effect of 3 single-molar implant designs on implant strains under a variety of homologous loading conditions. MATERIAL AND METHODS: On each implant abutment, 4 strain gauges were placed axially at 90 degrees to each other on the buccal, lingual, mesial, and distal surfaces. Effects of implant design, load location, direction, and magnitude were tested on axial and bending (buccolingual and mesiodistal) strains of 3 single-molar implant designs: (1) single, 3.75-mm (regular) diameter implant, (2) single, 5-mm (wide) diameter implant, and (3) two 3.75-mm diameter (double) implants connected through a single-molar crown. Results were analyzed with ANOVA. RESULTS: Variations in loading conditions induced 3-dimensionally complex abutment strains on the tested implant designs. Peak absolute strains in mesiodistal direction were 6493 microepsilon for design 1 and 3958 microepsilon on design 2, and 3160 microepsilon in buccolingual direction on design 3. For all loading conditions, the single 3.75-mm diameter implant consistently experienced the largest strains compared with wide-diameter and double implant designs. Changes in centric contact location affected implant abutment strains differently among the 3 designs. Angulated force direction resulted in larger bending strains. CONCLUSION: For single-molar implant designs, an increase in implant number and diameter may effectively reduce experimental implant abutment strains.